title: Repeat needle insertion in vertebroplasty to prevent re-collapse of the treated vertebrae.
abstract: OBJECTIVE
  Patients with un-relieved pain after vertebroplasty due to re-collapse of the cemented vertebrae have been reported. Here we report a technique of vertebroplasty that can reduce the incidence of re-collapse at the cemented vertebrae.
  
  
  METHODS
  Between March 2002 and September 2008, 134 patients with 205 painful vertebral compression fractures underwent vertebroplasty in our institutes. The indication of using this technique was unfilled area more than 25% of the vertebral body height in lateral radiograph. The vertebroplasty procedure was performed according to the technique described by Jensen. If the unfilled area were more than 25% of the vertebral body height in lateral radiograph, another needle would be inserted aiming at the unfilled area. As outcome measurement, a visual analog scale with 10 divisions and plain radiographs (to measure the anterior vertebral body height of cemented vertebrae) were used.
  
  
  RESULTS
  Thirteen vertebrae were treated with this technique. The mean age was 74.4 years. The immediate post-vertebroplasty anterior vertebral height was 24.92±3.59 mm, changed to 23.52±3.54 mm at final follow-up. The visual analog scale decreased from a mean of 8.7 before vertebroplasty to 2.3 at final follow-up. The follow-up duration ranged from 15 to 38 months (mean 18.5 months). There was no case of re-collapse of the cemented vertebrae, and no procedure-related complications.
  
  
  CONCLUSIONS
  In the treatment of vertebral compression fractures by percutaneous vertebroplasty, repeat needle insertion to the unfilled area may be helpful to decrease the incidence of re-collapse of cemented vertebrae if the unfilled area is more than 25% of the vertebral body height in lateral radiograph.
authors.affiliation: Department of Orthopedic Surgery, China Medical University Hospital, and School of Medicine, China Medical University, Taichung, Taiwan. yenjenc.tw@yahoo.com.tw
authors.forename: Yen-Jen
authors.initials: YJ
authors.lastname: Chen
authors.forename: Wen-Hsien
authors.initials: WH
authors.lastname: Chen
authors.forename: Hsien-Te
authors.initials: HT
authors.lastname: Chen
authors.forename: Horng-Chaung
authors.initials: HC
authors.lastname: Hsu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D005260:Female; D050815:Fractures, Compression / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D012008:Recurrence; D016103:Spinal Fractures / Q000601:surgery*; D016896:Treatment Outcome; D054854:Vertebroplasty / Q000379:methods*
chemical_list: D003287:Contrast Media